The recent announcement of a nationally commissioned ‘flu jab service via community pharmacy was as much of a surprise to community pharmacists like me as it was to GPs, albeit (for us) a fairly welcome one.
Now I could make the case that the predictably negative reaction from GPs is simply a territorial response. After the announcement that the weight-loss drug orlistat was going over the counter, I found myself on national radio defending a safe and perfectly-sensible change against a charge by doctors that we would all now drown in a tsunami of smelly steatorrhea as a result…
The truth, of course, is that pharmacists, like GPs, are committed professionals who do a very safe job. Quite simply patients often find our services more convenient.
However things are a little more complicated than that and I entirely understand why GPs perceive this as unwelcome especially at the time when they are already under extreme pressure and morale (not to mention recruitment) are both at rock bottom.
The shame of it is that we pharmacists were anticipating a different announcement entirely: one that GPs would have overwhelmingly supported; that would have been antibiotic-sparing; that would have saved over £1 billion of precious NHS cash; that could have freed-up 57m GP appointments a year. An announcement that would have saved thousands of out-of-hours, urgent and A&E appointments.
Pharmacy-led common ailments service
I am talking of course of a national, pharmacy-led, common ailments service.
I have argued for years that local community pharmacists and GPs are natural allies, caring for the same primary care populations. Our complimentary skills should be aligned in such a way as to best benefit those whom we all serve.
The enforced competition between GPs and pharmacists, just like the competition between primary and secondary care, is anathematic to the culture of health professionals and to the person-centred values of the NHS. It drives silo behaviours and exacerbates the tribalism which so frustrates the obvious benefits of working together.
The arguments in favour of aligning GP contracts with that of the community pharmacist have never been stronger. I’m acutely aware of the pressure GP colleagues are under and the desperate shortage of GPs. Surely it makes sense for community pharmacists, who are currently in abundant supply, to take some of the pressure away so that together we might fulfil the ambition expressed by RCGP, for 15 minutes appointments.
There are many community pharmacists, and I certainly count myself amongst them, who have no confidence in our negotiators (the Pharmaceutical Services Negotiating Committee). On the one hand they are always entreating us to work more closely with GP colleagues and on the other they have gone on record as saying that there is no need for GPs to support the pharmacy-led flu jab service. Well they can’t have it both ways.
Aligning GP and pharamcy contracts
But we cannot lay the blame for this obsession with competition and lack of a joined-up vision solely at the door of the PSNC. What on earth was NHS England thinking? Is it a classic divide and rule strategy?
Significantly, as I was drafting this article, a joint paper was published the Royal Pharmaceutical Society and the National Association of Primary Care. Nattily titled 'Improving patient care through general practice and community pharmacy integration' it starts to make the case for joint working and the alignment of our contracts.
Please be assured that the last thing we community pharmacists want is to be forced to compete against our GP colleagues. So let’s not exacerbate the differences between us in a polarised debate. Instead let’s seize the opportunity to come together and create a joint vision of how we can best work together for the future, for our patients, and to save the NHS.
- Graham Phillips is a superintendent pharmacist in Hertfordshire